Questionable Benefit of Cultures at the Time of Penetrating Keratoplasty

Reed, John W.; Bealer, Laura A.; Sloop, Catherine M.; Davis, Richard M.

doi:10.1097/00003226-199401000-00050

Cited by 5 publications

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“…However, the ICER for fungal infections was substantially less. Reed et al 45 estimated that in the US, submitting donor rims for microbiological testing costs US$2.5 million per year. Similarly, Wiffen et al 4 found that the cost of routine donor rim cultures cost US$137 per cornea transplanted in 1994, and that if this number was applied to the 43,743 corneal transplants performed that year in the US, it would be equivalent to $6 million.…”

Section: Discussionmentioning

confidence: 99%

The value of corneoscleral rim cultures in keratoplasty: a systematic review and cost-effectiveness analysis

Kiatos¹,

Armstrong²,

Hutnik

et al. 2017

CEOR

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PurposeThis study evaluated the performance of donor corneoscleral rim cultures for predicting infection after corneal transplantation, and determines if there is a correlation between positive corneoscleral rim cultures and postkeratoplasty infection.Design and data sourcesThis was a systematic review, prognostic accuracy analysis, and cost-effectiveness analysis. Databases searched were: Medline (Ovid), Embase (Ovid), CINAHL, Cochrane Library, Web of Science, and BioSis Previews. Grey literature was also explored.Materials and methodsA systematic review was conducted to locate published and unpublished studies. All studies examining corneal button contamination and its association with endophthalmitis and keratitis posttransplantation were included. Extracted data were used to calculate sensitivity, specificity, positive predictive value, and negative predictive value. Cost data from the London Laboratory Services Group in London, ON were used to calculate the cost-effectiveness of culturing donor rim cultures.ResultsOf 7,870 grafts, 954 had a positive rim culture (12.1%), with 12 patients going on to develop keratitis or endophthalmitis (1.3%). The prevalence of keratitis and endophthalmitis in this study was 0.15%, and the positive predictive value 1.5%. Of the 12 infections, nine were fungal and three bacterial. The estimated cost of a positive and negative test result was CAD$45.99 and $14.15, respectively. The cost to run all 7,870 tests was estimated to be $141,735.86, with an incremental cost-effectiveness ratio of $40,215.70.ConclusionThere was a significant divergence between bacterial and fungal rim-culture results. Bacterial cultures predicted clinical infection poorly, did not change management, and were expensive. Fungal cultures predicted clinical infection in over 10% of patients, had the potential to change management, and were 40% less expensive than full rim culturing (bacterial and fungal tests). Fungal rim cultures may be considered in areas where fungal infection rates are high.

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Section: Discussionmentioning

confidence: 99%

The value of corneoscleral rim cultures in keratoplasty: a systematic review and cost-effectiveness analysis

Kiatos¹,

Armstrong²,

Hutnik

et al. 2017

CEOR

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“…Many studies have showed no benefit of positive cultures with respect to anticipating the development of endophthalmitis, concluding that there is no positive predictive value from routine cultures. [7][8][9][10][11][12][13][14][15][16] Other studies have demonstrated a clearer value to culturing donor tissue in the management of transplants. [17][18][19] We can question the clinical benefit of routinely screening donor tissue if management is based on the clinical course rather than culture results.…”

Section: Discussionmentioning

confidence: 99%

Prevalence of Positive Microbiology Results From Donor Cornea Tissue in Different Methods of Corneal Transplantation

Garg

Said

Farid

et al. 2013

Cornea

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“…Values from other eye banks vary widely from 4 to 37% for hypothermic storage (Pardos & Gallagher 1982; Kloess et al. 1993; Reed et al. 1994; Gomes et al.…”

Section: Discussionmentioning

confidence: 99%

“…During the period reported here, a median of 5.3% of all donor corneas were discarded because of contamination. Values from other eye banks vary widely from 4 to 37% for hypothermic storage (Pardos & Gallagher 1982;Kloess et al 1993;Reed et al 1994;Gomes et al 1995) and 0.6% to 16% for organ culture storage (Erbezci et al 1995;Hagenah et al 1995;Builles et al 2006;Fontana et al 2007;Hermel et al 2010). The contamination rate in our study increased significantly between 2006 and 2007 and reaching 19.4% in 2008 and 17.4% in 2009.…”

Section: Discussionmentioning

confidence: 99%

Thirty years of cornea cultivation: long-term experience in a single eye bank

Linke

Eddy

Bednarz³

et al. 2012

Acta Ophthalmologica

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ABSTRACT.Purpose: To evaluate donor demographics, trends in donor tissue procurement and tissue storage over a long period. Methods: A retrospective, longitudinal, descriptive analysis was undertaken of data from the Hamburg Eye Bank Data Base (HEB-DB) that had been collected between 1981 and 2010. Data on 54 parameters of cornea donors [including clinical history, age, death cause, gender and death-to-explantation interval (DEI)] and of cultivated corneas (endothelial quality and development in culture, cultivation period, microbiological contamination) were retrieved. These data were analysed statistically, focusing on the historical development of the eye bank. Results: At the time of retrieval (June 2010), the HEB-DB contained data on 10 943 corneas (5503 donors). Most donors were men (65%) and had died from cardiopulmonary (n = 801) ⁄ cerebral (n = 261) failure or as the result of a polytraumatic accident ⁄ suicide (n = 602). Within these years, donor age, DEI and storage time increased. The percentage of stored corneas suitable for transplantation displayed a variable but increasing trend; in 2007, almost 75% of the stored corneas were transplanted. Between 1995 and June 2010, the median microbiological contamination rate was 5.3%. A change in the procurement procedure from enucleation to corneoscleral explantation in 2008 led to a briefly increased contamination rate. Conclusion: Donor demographic data run parallel to the general demographic development. Our analysis indicates a dynamic development of the eye bank over the last 30 years and emphasizes the need for an active quality management in coping with the challenges of modern eye banking.

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Questionable Benefit of Cultures at the Time of Penetrating Keratoplasty

Cited by 5 publications

References 0 publications

The value of corneoscleral rim cultures in keratoplasty: a systematic review and cost-effectiveness analysis

The value of corneoscleral rim cultures in keratoplasty: a systematic review and cost-effectiveness analysis

Prevalence of Positive Microbiology Results From Donor Cornea Tissue in Different Methods of Corneal Transplantation

Thirty years of cornea cultivation: long-term experience in a single eye bank

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